The Institute of Medicine and the Agency for Healthcare Research and Quality (AHRQ) have highlighted the major disparities in health care based on race. Racial disparities exist for many medical conditions, including those requiring orthopedic surgery procedures. Although the etiology of health disparities is complex, communication between health care providers and patients may play an important role. Because differences in the rates of surgical procedures, such as those in orthopedic surgery, are large, understanding racial differences in communication in surgical settings is critical. Thus, the specific aim of this study is to explore racial differences in communication between African American and White American patients and orthopedic surgeons using analysis of audiotaped office visits. An existing dataset of questionnaires and audiotaped office visits between orthopedic surgeons practicing in the Chicago area and their patients who are 60 years or older will be used. The specific sample for this study will include 30 African American (AA) and 29 White patients, matched for socioeconomic status and gender, who are all considering a complex surgical procedure. A qualitative descriptive approach (conversation analysis) will be used to explore patterns of communication. Similarities and differences based on race will be identified. Results of this work will be synthesized and disseminated to the American Academy of Orthopedic Surgeons (AAOS). This AAOS will work with the investigators to determine the appropriate forums for dissemination of the work to practicing orthopedic surgeons, including written publications and presentation at the National meeting. This work has the potential to advance understanding of racial disparities by direct observation of communication in real world encounters in surgery, where disparities in procedures are apparent. The results will form the base for educational efforts with the AAOS and for broader investigations of racial disparities in surgery. [unreadable] [unreadable] [unreadable] [unreadable]